John McCain's Surgery Is Just the Start of Republicans' Problems

The US senator's blood clot could have long-term ramifications for Trump's agenda in Congress.

Over the weekend, America learned that the state of John McCain's eye may be the only thing stopping the disastrous Republican healthcare bill. The 80-year-old US senator from Arizona had a blood clot removed from near his left eye on Friday; as a result, a planned procedural vote to advance the Senate healthcare vote is being delayed. Republicans need 50 votes from their majority of 52 to push the deeply controversial bill forward, and since two Republican senators have already signaled their opposition (with several others undecided), McCain needs to be in the Senate for anything to actually happen.

It's just the latest setback for a GOP leadership already facing a time crunch so extreme that Senate Majority Leader Mitch McConnell is delaying the start of the August recess by two weeks. That move gave his team more time to broker a compromise between conservatives who want to take government out of the health insurance market pretty much entirely and moderates concerned about how the bill would roll back Medicaid expansion—and leave some 20 million more people without insurance by 2026.

But McCain's potentially weeks-long recovery also gives McConnell's opponents a fresh opportunity to agitate against the bill. For instance, on Monday, a coalition of major businesses issued a warning that the bill would raise costs on hospitals, which would then be passed on to employers that already provide health insurance to their workers.

The longer the healthcare bill is delayed, the more pressure that will fall on a small group of Republican senators from both the right and the left. McCain's surgery added to that pressure, but even without the fateful blood clot, the GOP was facing problems. Let's count them:

The bill is incredibly unpopular. As Democrats found out in 2009, even if people are unhappy with the US healthcare system (and they have reason to be), making big changes to it is bound to be unpopular. Proposed changes seem to be even less popular when they would result in fewer people having insurance: According to some of the latest polling, 50 percent of Americans prefer the status quo (a.k.a. Obamacare) compared to just 24 percent who back the Republican proposal. If there's some magic marketing strategy that can convince the public that massive cuts to Medicaid and fewer insured people are good things, Republicans haven't found it.

The president doesn't care about it. If anyone could find a way to sell the bill, it would be Donald Trump, who despite everything is enormously popular with Republicans (though definitely not the public as a whole). But the famed reality TV star and marketer has taken a back seat during this process, telling senators a few weeks ago that it would be "OK" if the bill didn't pass, though he later added that he would be angry. Either way, Trump has generally been checked out on this whole struggle.

The process was chaotic from the start. As documented in a new Politico story, many Republicans—both in the incoming administration and Congress—figured repealing and replacing Obamacare would be as easy as simply passing a bill that reversed the Affordable Care Act, then worrying about the "replace" part later. But the ACA had given so many people insurance that getting rid of it outright was too politically toxic. Even a partial repeal is pretty damn difficult, as the GOP is learning.

Healthcare is just the start. Back when passing the healthcare bill was supposed to be a quick affair, Republicans saw it as a precursor to tax reform, a.k.a. tax cuts, because tax cuts generally are the last issue unifying all the factions of the GOP. And reports indicate the White House is preparing a tax plan now. But even when it comes to taxes, there are divisions in the party (for example, over something called a border adjustment tax). A long, contentious fight over the healthcare bill doesn't bode well for the future.

Oh yeah, there's the debt ceiling, too. The US government won't be able to pay off all its creditors starting sometime this fall unless the debt ceiling is raised. This could be a simple process (it's not a matter of approving new spending, after all), but the far-right Freedom Caucus in the House is insisting on concessions before they'll back any increase. GOP leaders want to sort this out before they leave for their recess in August, but these negotiations—which may not get going in earnest until healthcare gets figured out—will create a new set of problems.

Finally, at some point, America needs a new budget. Months ago, Congress reached a deal on a short-term budget that would keep the government open until September. Since then, House lawmakers have been working on a big omnibus spending bill—but since any such bill will have to attract the support of some Democrats in the Senate, passing it will be tricky. If Congress doesn't pass a new spending bill before leaving in August, when legislators get back to work on September 5, they'll have to quickly hammer out a deal to keep the government open.

If the federal government shuts down, or defaults on its debts (a worst-case scenario), there will be no one to blame but the party now fully in charge. Controlling all three branches of government, Republicans have learned, comes with a lot of headaches—even when one of your key members isn't recovering from surgery.